If you want to talk to someone in Singapore, national mindline 1771 is available round the clock, the Samaritans of Singapore helpline is 1767, and the Institute of Mental Health helpline is 6389 2222. In an emergency, call 995. Our guide to mental health in Singapore has more.
Key facts
- These medicines change craving and reward, not willpower. That reframing is most of what makes them work.
- None of them is a cure, and all of them do better alongside support than alone. The honest gain is a meaningful shift in the odds, not a transformation.
- Do not stop heavy daily drinking abruptly on your own. Alcohol withdrawal can be dangerous, including seizures, and this is the one genuine emergency in the article.
- Disulfiram is not a deterrent to experiment with. Its reaction with alcohol is serious and it is prescribed under supervision.
- The boxed warning on varenicline was removed in 2016 after a large safety trial (FDA label). Mood changes are still worth watching, but the old warning is not current.
- Bupropion appears twice, here and as an antidepressant, so say what you already take.
- Naltrexone and opioid painkillers interact. Tell whoever prescribes.
Nobody decides to drink more. What happens is that you arrive somewhere new, and the way people meet is over drinks, and drinks are inexpensive, and the friends you are making are also new so nobody has a baseline for you. Thursday becomes a night out because Friday is flexible. The measures at home are generous because you pour them. Nobody at work knew you before, and nobody at home can see you.
Two years in, four drinks on a weeknight is unremarkable within your group, and your group is the only reference you have.
That is not a moral failure and it is not unusual. It is a predictable consequence of an environment, and it is worth naming plainly because the alternative is that people only recognise it through a category they refuse to apply to themselves.
Why willpower is the wrong frame
If drinking or smoking were a matter of deciding, most people would have finished with it years ago, because most people have decided repeatedly.
What these substances change is the reward system: the loop that assigns value, produces anticipation, and makes the absence uncomfortable. Deciding operates on a different part of the machinery, and it is asked to win an argument it did not choose to have, several times a day, indefinitely.
Medicines work on the loop rather than on the decision. That is why they help, and also why they are not a substitute for the rest of the work. They make the decision winnable more often. They do not make it for you.
The five, and what each honestly does
| Medicine | What it actually changes | The honest catch |
|---|---|---|
| Naltrexone | Blunts the reward from alcohol, so drinking is less rewarding | Interacts with opioid painkillers; liver monitoring may be needed |
| Acamprosate | Helps a brain adjusting to the absence of alcohol; aimed at staying stopped | Taken several times a day, which asks something of you |
| Disulfiram | Makes drinking cause a genuinely unpleasant reaction | Only works if taken; strictly supervised, not a self-service deterrent |
| Varenicline | Reduces both craving and the satisfaction of smoking | Nausea and vivid dreams are common; mood worth monitoring |
| Bupropion | Reduces craving; also an antidepressant | Not for everyone, including some with seizure risk |
Browse the shelf under addiction recovery, or by condition under alcohol dependence, tobacco dependence and smoking cessation. Singapore’s I Quit programme is the local support side of the smoking half, and HealthHub also covers varenicline directly.
Three notes that matter more than the table.
Disulfiram is different in kind. It does not reduce craving at all. It changes the arithmetic by making drinking produce a reaction, which can be severe. That is why it is prescribed and supervised, why the person taking it has to want it, and why it is never something to obtain and try out.
Varenicline’s reputation is out of date. For years it carried a boxed warning about serious neuropsychiatric effects. That warning was removed from the label in December 2016 following a large trial specifically designed to test it. Mood changes are still listed and still worth watching, and anyone with a history of depression should say so. But people repeat the old warning as current, and it has kept people away from one of the more effective options.
Bupropion is on this site in two roles, here and among the antidepressants. Someone already taking it for mood should not be given it again for smoking, which is an easy thing to prevent by saying what you take. Our article on antidepressants when you live abroad covers the other role.
The honest limits
This is the part most articles skip, so here it is directly.
None of these produces a dramatic result on its own. They shift the odds. Combined with support, whether counselling, a programme or a structured attempt, they shift them considerably more, and the evidence is consistently for medicine plus support rather than either alone. The World Health Organization is blunt about how difficult tobacco is to leave and how much support matters.
Most people take more than one attempt. That is the normal pattern, not the failure pattern, and treating a relapse as proof that nothing works is how people stop trying. A medicine that did not suit you is information about that medicine.
They do not address why. If the drinking is doing a job, managing anxiety, filling isolation, making an unmanageable posting manageable, then removing it without addressing the job creates a gap. That is not an argument against treatment; it is an argument for the support half.
The parts that are specific to living here
Nobody has a baseline for you. The friend who would have said something knew you for fifteen years and lives eleven time zones away. New friends have only ever known this version.
Drinking is the social infrastructure, particularly in the first year, and more so where the expat scene is small. Stopping is not only a change to your evenings; it is a change to how you meet people, and pretending otherwise sets people up to be blindsided by the loneliness of it. Worth planning for rather than discovering.
Care is fragmented. The doctor treating your blood pressure may not be the doctor you would tell about this, and there may be no single record. That makes saying it out loud more important, not less.
The privacy question is real, and worth asking about directly at a clinic rather than guessing, especially where employment or insurance is involved.
The one genuinely unsafe thing
If you drink heavily every day, do not stop abruptly on your own.
Alcohol withdrawal in a physically dependent person is not simply unpleasant. It can cause tremor, agitation, confusion, hallucinations and seizures, and in its severe form it is a medical emergency. This is the one area where the dramatic version of stopping, going cold turkey alone, is the actively dangerous option.
Medically supported withdrawal exists precisely for this, it is routine, and it is not a judgement on anyone. If you are in this category, that is the conversation to start with, before any of the medicines above are relevant.
Smoking has no equivalent. Stopping is uncomfortable, not dangerous.
Also worth reading
For getting care rather than medicine, see mental health in Singapore. For bupropion in its other role, see antidepressants when you live abroad. For the sleep that so often sits underneath all of this, see sleep, jet lag and insomnia in Thailand.
FAQ
Can I take something to cut down rather than stop?
Reduction is a legitimate goal that some approaches are aimed at, and it suits some people better than abstinence. It is a real conversation to have rather than a lesser ambition to apologise for.
Will my doctor here judge me?
Doctors deal with this constantly and are considerably less interested in judging than people expect. If a particular clinic feels wrong, that is a reason to try another rather than to go without.
Do I have to call myself an alcoholic to get help?
No. The label is not the entry requirement. Describing what you actually do, in numbers of drinks and days, is more useful to a doctor than any category.
Is vaping a reasonable way to stop smoking?
It is treated very differently between countries in this region, including where it is not permitted at all, so the local legal position matters before anything else. Ask about what is available and lawful where you are.
Are these available across the region?
Availability varies by country, and continuity is the usual practical problem. The country guides cover how prescribing and supply work in each place.
Sources
- World Health Organization, alcohol fact sheet
- World Health Organization, tobacco fact sheet
- HealthHub Singapore, I Quit programme
- HealthHub Singapore, varenicline
- US FDA, Chantix (varenicline) label, boxed warning removed 12/2016
This article is general information, checked on 10 August 2026. It contains no doses and no schedules, and it is not a substitute for advice from a clinician.
